To compare outcomes between surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve (BAV) stenosis.
Approach:
Study Design: Retrospective cohort study of 480 patients with BAV stenosis, comparing 75 TAVI and 405 SAVR patients.
Data Analysis: Primary analyses adjusted for age, sex, and comorbidities; sensitivity analysis used 1:1 age matching.
Key Findings:
TAVI was associated with higher mortality (adjusted HR = 5.9, 95% CI 2.6–12.9, p < 0.001).
Higher rates of pacemaker implantation in TAVI group (19% vs. 4%; HR = 2.6, 95% CI 1.1–6.7, p < 0.001).
Increased paravalvular leak in TAVI group (adjusted OR = 5.8, 95% CI 2.6–12.7, p < 0.001).
Higher heart failure hospitalizations in TAVI group (IRR=7.7, 95% CI 2.7–22.2, p < 0.001).
Stroke rates were similar between TAVI and SAVR.
Interpretation:
SAVR was associated with better survival and fewer complications compared to TAVI in patients with BAV stenosis.
Limitations:
Retrospective design may introduce selection bias.
Limited generalizability due to single-center study.
Conclusion:
SAVR is associated with better outcomes than TAVI in BAV stenosis.
by Kobi Faierstein, Tal Caller, Dassi Moshkovitz, Efrat Sharon, Roy Raphael, Ido Cohen, Noam Makmal, Efrat Mazoe Dray, Afek Ash, Elad Maor, Ehud Regev, Amit Segev, Israel M. Barbash, Paul Fefer
